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2025-2026 ELC Pre-Kindergarten Enrollment 
Please complete this form if you have a child who will be 4 years old by August 1, 2025. This form serves only as a time and date stamp of your enrollment for placement on a class list. After the completion of this form, please reference the enrollment directions back on the district's Early Learning webpage for next steps to complete the enrollment process. 
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Email *
#1 Parent/Guardian Name and Relationship to Student: *
#1 Parent/Guardian Phone Number: *
#1 Parent/Guardian Email: *
#1 Parent/Guardian Home Address: *
#2 Parent/Guardian Name and Relationship to Student:
#2 Parent/Guardian Phone Number:
#2 Parent/Guardian Email:
#2 Parent/Guardian Home Address:
Student Name: *
Student Date of Birth: *
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Student Gender: *
Student Race: *
Does the student live in-district or out-of-district in regards to the Lone Jack School District?
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Student Home Address: *
Is your student currently receiving services from Missouri First Steps or on an Individualized Education Plan (IEP)?
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Please list all health, allergy, medication, social/emotional, behavior or any other concerns you would want your student's teacher to be aware of: *
Information or photos that include my student may be released to the newspaper, school newsletter, school facebook page, etc.
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Select the preferred class time and schedule that would most benefit your child.  *
Will you also be enrolling your student in before and after school childcare through the AMPM Mini Mules program? 
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A copy of your responses will be emailed to the address you provided.
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